A Case of Appendiceal Intussusception Caused by Heterotopic Endometriosis

Abstract

A 40-year-old woman presented complaining of hematochezia. On lower gastrointestinal endoscopy, a submucosal tumorous elevation was identified in the cecum. Contrast-enhanced computed tomography showed thickening of the cecal wall, and diffusion-weighted magnetic resonance imaging showed a hyperintensity at the same site. Appendiceal cancer was suspected, and laparoscopic ileocecal resection was performed. On gross inspection of the resected sample, the appendix had become inverted into the cecal lumen, a sign of appendiceal intussusception. On histopathological examination, there were patches of glands resembling endometrial tissue from the muscularis propria to the subserosal layer, and appendiceal intussusception caused by heterotopic endometriosis was diagnosed. Endometriosis-induced appendiceal intussusception is a rare condition, and its preoperative diagnosis is considered difficult. A case of appendiceal intussusception caused by heterotopic endometriosis that was difficult to differentiate from appendiceal tumor is presented along with a discussion of the literature.